RESUMO
Aeromonas is well-recognized for causing diarrhea and post-traumatic wound infections. The most common Aeromonas species include Aeromonas hydrophila, Aeromonas caviae, and Aeromonas sobria. In cases of immunocompromise and malignancy, Aeromonas infections can prove fatal. Instances of deadly necrotizing fasciitis in the extremities due to Aeromonas infection have been documented. Herein, a case of previously unreported fatal retroperitoneal necrotizing fasciitis involving Aeromonas caviae in a patient with a history of gastric cancer is presented.
Assuntos
Aeromonas caviae , Fasciite Necrosante , Infecções por Bactérias Gram-Negativas , Humanos , Fasciite Necrosante/microbiologia , Fasciite Necrosante/diagnóstico , Infecções por Bactérias Gram-Negativas/microbiologia , Evolução Fatal , Masculino , Espaço Retroperitoneal/microbiologia , Espaço Retroperitoneal/patologia , Sepse/microbiologia , Idoso , Pessoa de Meia-IdadeRESUMO
We treated an 85-year-old man with an abscess perforating into the retroperitoneal space from the sigmoid colon, with retroperitoneal drainage combined with antibiotics. CT showed no abscess formation in the intraperitoneal space. The patient consulted a doctor with a chief complaint of left-side low back pain and fever. He was first diagnosed with bacteremia due to Escherichia coli and close examination by CT revealed a retroperitoneal abscess. On referral to our hospital, we determined by CT that the cause of abscess formation was perforation of the intestine into the retroperitoneal space and spreading into the psoas muscle compartment. We then performed colostomy and abscess drainage through the retroperitoneal space to prevent the abscess disseminating into the intraperitoneal space. The abscess and necrotic tissue cultures were polymicrobial, including Enterobacteriaceae and Bacteroides spp. The abscess almost disappeared after drainage, and the patient's general condition gradually improved. The retroperitoneal abscess did not relapse by follow-up CT. In conclusion, this rare case presented with perforation of the intestine (Sigmoid colon) disseminated only to the retroperitoneal space without no intraperitoneal space abscess formation. We performed drainage only by a retroperitoneal approach without entering the intraperitoneal space.
Assuntos
Abscesso Abdominal/microbiologia , Abscesso/microbiologia , Antibacterianos/uso terapêutico , Coinfecção/diagnóstico , Coinfecção/terapia , Colo Sigmoide/lesões , Drenagem/métodos , Perfuração Intestinal/complicações , Espaço Retroperitoneal/microbiologia , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Abscesso/complicações , Idoso de 80 Anos ou mais , Bacteroides , Coinfecção/microbiologia , Colo Sigmoide/patologia , Colostomia , Enterobacteriaceae , Escherichia coli , Febre/etiologia , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/cirurgia , Masculino , Espaço Retroperitoneal/diagnóstico por imagem , Espaço Retroperitoneal/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Necrotising fasciitis (NF) is a potentially lethal spread of infection that is uncommonly seen within the province of surgery. Seen mostly in the extremities and the perineal regions, it has been reported rarely to involve the retroperitoneal space and presents with a spectrum of symptoms and signs as such. Literature supports classification of NF based on the microbes involved. Irrespective of the aetiology and the causative organism, NF remains a serious surgical emergency with high morbidity and mortality not only associated with the disease process itself, but also with the extensive surgical debridement it requires in its management along with antimicrobial administration. We present a case of such an infection found in the retroperitoneal space secondary to a perineal infection forming a rare presentation of this deadly process, and how it was successfully managed secondary to timely surgical intervention.
Assuntos
Fasciite Necrosante/diagnóstico por imagem , Períneo/microbiologia , Espaço Retroperitoneal/microbiologia , Administração Intravenosa , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Colostomia/métodos , Corynebacterium/isolamento & purificação , Desbridamento , Fasciite Necrosante/tratamento farmacológico , Fasciite Necrosante/cirurgia , Feminino , Humanos , Jejunostomia/métodos , Laparotomia/métodos , Períneo/diagnóstico por imagem , Períneo/patologia , Períneo/cirurgia , Espaço Retroperitoneal/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoAssuntos
Abdome Agudo/patologia , Injúria Renal Aguda/diagnóstico , Traumatismos da Medula Espinal/complicações , Abdome Agudo/diagnóstico por imagem , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/cirurgia , Antibacterianos/uso terapêutico , Citrobacter koseri/isolamento & purificação , Drenagem/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal/microbiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologiaRESUMO
BACKGROUND: Several infectious processes of intra-abdominal origin may atypically present as skin or soft tissue infections or abscess in the thigh. CASE REPORT: We describe the case of a 73-year-old woman who presented to the emergency department with the clinical picture of a skin infection of the right leg. The patient's condition deteriorated during medical treatment with intravenous antibiotics. Subsequent radiologic imaging revealed that the complaints were caused by a bulging retroperitoneal appendicular abscess along the iliopsoas muscle, although the patient experienced no abdominal symptoms. The patient recovered completely after surgical intervention. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Timely performance of anatomic imaging in patients with unexplained skin or soft tissue infections and thigh abscesses is important because these findings may be manifestations of an abdominal pathology. A correct diagnosis in the emergency department prohibits delays in treatment.
Assuntos
Apendicite/diagnóstico , Celulite (Flegmão)/diagnóstico , Infecções dos Tecidos Moles/terapia , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Apendicite/complicações , Cefuroxima/farmacologia , Cefuroxima/uso terapêutico , Celulite (Flegmão)/tratamento farmacológico , Serviço Hospitalar de Emergência/organização & administração , Escherichia coli/patogenicidade , Feminino , Humanos , Klebsiella pneumoniae/patogenicidade , Imageamento por Ressonância Magnética/métodos , Metronidazol/farmacologia , Metronidazol/uso terapêutico , Piomiosite/diagnóstico , Espaço Retroperitoneal/anormalidades , Espaço Retroperitoneal/microbiologia , Infecções dos Tecidos Moles/complicações , Coxa da Perna/anormalidadesRESUMO
Laparoscopic cholecystectomy is the golden standard, considering treatment of cholelithiasis. During the laparoscopic procedure one may often observe damage to the gall-bladder wall, as well as presence of gall-stones in the peritoneal cavity, as compared to classical surgery. These gall-stones may be associated with the occurrence of various complications following surgery. The study presented a rare case of a retroperitoneal abscess, as a consequence of retained gall-stones, in a female patient who was subject to laparoscopic cholecystectomy two years earlier.
Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Cálculos Biliares/cirurgia , Espaço Retroperitoneal/diagnóstico por imagem , Espaço Retroperitoneal/microbiologia , Abscesso Subfrênico/diagnóstico por imagem , Abscesso Subfrênico/microbiologia , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Staphylococcus aureus/isolamento & purificação , Abscesso Subfrênico/tratamento farmacológicoRESUMO
Aggregatibacter aphrophilus is an uncommon cause of vertebral infections and its complications are infrequently seen. We believe ours is the first reported case of scrotal abscess as a complication of vertebral osteomyelitis. We have also reviewed nine cases with complications similar to this report. Epidural abscess is the most commonly found complication, having been reported in six patients, followed closely by psoas abscess, which was seen in five patients. All except one patient underwent surgical drainage, with all patients showing complete resolution of infection.
Assuntos
Infecções por Pasteurellaceae/diagnóstico , Abscesso do Psoas/microbiologia , Espaço Retroperitoneal/microbiologia , Hidrocele Testicular/microbiologia , Adulto , Aggregatibacter aphrophilus/isolamento & purificação , Epididimite/microbiologia , Humanos , Masculino , Osteomielite/complicações , Osteomielite/microbiologiaRESUMO
Retroperitoneal abscesses present a relatively uncommon complication of diseases of various abdominal organs, although most commonly they are related to acute appendicitis of retrocoecal location. The paper presents the case of a healthy patient in whom an excessive left retroperitoneal abscess developed, perforated into the peritoneal cavity, and almost perforated through the skin in XIIth intercostal space. The patient had no abdominal symptoms or signs, but complained from slight pain in the left lumbar area. The diagnosis was established based on abdominal computed tomography scanning and an operative treatment by laparotomy. The evacuation and drainage of the abscess was effective and the patient recovered. Bacteriological examination of the pus from the abdominal cavity revealed single colonies of anaerobic Fusobacterium species. The cause of the occurrence of the abscess remained unknown.
Assuntos
Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/microbiologia , Abscesso Abdominal/cirurgia , Fusobacterium , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal/diagnóstico por imagem , Espaço Retroperitoneal/microbiologia , Espaço Retroperitoneal/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Combined method of laparoscopically and retroperitoneoscopically assisted necrsequestrectomy, consisting of staged application of miniinvasive methods with simultaneous laparoscopic and retroperitoneoscopic control of necrsequestrectomy, was elaborated with the objective to improve surgical treatment of an acute pancreatitits. The procedure has significant advantages over open operative intervention in purulent complications of necrotic purulent pancreatitis: reduction of the local and systemic operative treatment severity, minimization of microbial metabolites coming into the blood, total visual control of intervention, reduction of the vascular injuries risk, аdequate surgical sanation with saving of viable pancreatic parenchyma, absence of conditions for the purulent complications occurrence while the operative wound healing is going on, preservation of possibility for an adequate draining, using drains of a large diameter.
Assuntos
Laparoscopia/métodos , Pâncreas/cirurgia , Pancreatectomia/métodos , Pancreatite Necrosante Aguda/cirurgia , Espaço Retroperitoneal/cirurgia , Supuração/cirurgia , Idoso , Antibacterianos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Drenagem/instrumentação , Drenagem/métodos , Feminino , Humanos , Laparoscopia/instrumentação , Pâncreas/microbiologia , Pâncreas/patologia , Pancreatectomia/instrumentação , Pancreatite Necrosante Aguda/tratamento farmacológico , Pancreatite Necrosante Aguda/microbiologia , Pancreatite Necrosante Aguda/patologia , Espaço Retroperitoneal/microbiologia , Espaço Retroperitoneal/patologia , Supuração/tratamento farmacológico , Supuração/microbiologia , Supuração/patologia , Resultado do TratamentoRESUMO
It was analyzed the treatment results of 108 patients with pancreonecrosis (PN). Gas-liquid chromatography with definition of blood concentration of volatile fatty acids (VFA) was used additionally for timely diagnostics of infected pancreonecrosis. Volatile fatty acids are toxic metabolites of microorganisms. Statistically significant threshold values of VFA were revealed. These values allow to diagnose timely early phase of PN infection and the nature of the microflora. It was defined changes of VFA depending on the severity of infectious process in pancreas and retroperitoneal fiber.
Assuntos
Bactérias/metabolismo , Cromatografia Gasosa/métodos , Ácidos Graxos Voláteis , Pancreatite Necrosante Aguda , Espaço Retroperitoneal/microbiologia , Adulto , Bactérias/classificação , Gerenciamento Clínico , Diagnóstico Precoce , Ácidos Graxos Voláteis/análise , Ácidos Graxos Voláteis/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/microbiologia , Pancreatite Necrosante Aguda/fisiopatologia , Pancreatite Necrosante Aguda/terapia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Federação Russa , Índice de Gravidade de DoençaRESUMO
Hydatid disease is a zoonotic infection resulting from the tissue infestation of the larval stage of the parasite Echinococcus granulosus. Hydatid cysts superinfected with pyogenic organisms have been reported previously. Brucellosis is more prevalent in people with close contact to animals and those consuming fresh milk or fresh milk products. Although these two disorders have some similar epidemiological features, we did not encounter any hydatid cyst cases superinfected with Brucella species (sp.) in a search of medical literature (Pubmed). Here, we present a case of hydatid cyst disease superinfected with Brucella and review the literature on other hydatid cyst cases superinfected with pyogenic organisms. We conclude that in regions where brucellosis and hydatid cysts are endemic, cysts may be infected with Brucella sp.
Assuntos
Brucella/isolamento & purificação , Brucelose/diagnóstico , Equinococose/complicações , Equinococose/diagnóstico , Echinococcus granulosus/isolamento & purificação , Espaço Retroperitoneal/patologia , Adulto , Animais , Brucelose/patologia , Equinococose/patologia , Humanos , Masculino , Espaço Retroperitoneal/microbiologia , Espaço Retroperitoneal/parasitologiaAssuntos
Discite/microbiologia , Infecções por Mycobacterium não Tuberculosas/complicações , Espaço Retroperitoneal/microbiologia , Coluna Vertebral/microbiologia , Antibacterianos/uso terapêutico , Descompressão Cirúrgica , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/terapia , Micobactérias não Tuberculosas , Fusão Vertebral , Estenose Espinal/microbiologia , Coluna Vertebral/cirurgiaAssuntos
Humanos , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal/microbiologia , Espaço Retroperitoneal/fisiopatologia , Abscesso/complicações , Abscesso/diagnóstico , Doenças da Bexiga Urinária/complicações , Doenças da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/diagnóstico , Espaço Retroperitoneal , Doenças da Bexiga Urinária/patologia , Doenças da Bexiga Urinária , /métodos , Mycobacterium bovis/isolamento & purificaçãoAssuntos
Abscesso/microbiologia , Abscesso/patologia , Corantes Azur/metabolismo , Klebsiella oxytoca/fisiologia , Azul de Metileno/metabolismo , Espaço Retroperitoneal/microbiologia , Espaço Retroperitoneal/patologia , Sarcoma/diagnóstico , Xantenos/metabolismo , Abscesso/diagnóstico por imagem , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Doença Crônica , Diagnóstico Diferencial , Humanos , Masculino , Espaço Retroperitoneal/diagnóstico por imagem , Tomografia Computadorizada por Raios XAssuntos
Abscesso Abdominal/diagnóstico , Infecções Pneumocócicas/diagnóstico , Streptococcus pneumoniae , Abscesso Abdominal/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Cefotaxima/uso terapêutico , Humanos , Masculino , Pelve/microbiologia , Infecções Pneumocócicas/tratamento farmacológico , Pristinamicina/uso terapêutico , Espaço Retroperitoneal/microbiologia , Rifampina/uso terapêutico , Adulto JovemRESUMO
Retroperitoneal abscesses are uncommonly encountered clinical entities and they represent serious surgical infections associated with significant mortality rates because of their insidious clinical manifestations and diagnostic difficulty. The source of retroperitoneal infections is usually an organ contained within or abutting the retroperitoneum, usually the kidney and the microorganisms most commonly isolated are gram-negative bacilli. Gram-positive cocci, mainly staphylococcal species and rarely streptococcal species, are a less common cause of retroperitoneal abscess and are usually isolated in cases of hematogenous spread. Treatment of retroperitoneal abscesses includes identification and treatment of underlying conditions, intravenous antibiotics and adequate surgical drainage of all well-defined collections. We present a rare case of retroperitoneal abscess caused by monomicrobial Streprococcus mutans infection and discuss the possible pathogenesis, clinical presentation, diagnosis and treatment.
Assuntos
Abscesso Abdominal/diagnóstico por imagem , Espaço Retroperitoneal/diagnóstico por imagem , Infecções Estreptocócicas/diagnóstico por imagem , Streptococcus mutans/isolamento & purificação , Abscesso Abdominal/microbiologia , Abscesso Abdominal/fisiopatologia , Dor Abdominal/etiologia , Idoso , Diagnóstico Tardio , Febre/etiologia , Humanos , Masculino , Espaço Retroperitoneal/microbiologia , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
Cryptococcoma is a rare entity, characterized by solid, space-occupying masses, usually found in the brain. It has been reported in the setting of "paradoxical" immune reconstitution inflammatory syndrome. A case of retroperitoneal cryptococcoma in a HIV-infected woman with a clinical history of disseminated cryptococcosis on antifungal maintenance therapy is described.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Antifúngicos/administração & dosagem , Criptococose/diagnóstico , Criptococose/patologia , Espaço Retroperitoneal/microbiologia , Espaço Retroperitoneal/patologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/patologia , Biópsia , Criptococose/tratamento farmacológico , Feminino , Histocitoquímica , Humanos , Microscopia , Pessoa de Meia-IdadeAssuntos
Traumatismos Abdominais/complicações , Miosite/complicações , Choque Séptico/etiologia , Infecções Estreptocócicas/etiologia , Streptococcus pyogenes/isolamento & purificação , Ferimentos não Penetrantes/complicações , Traumatismos Abdominais/diagnóstico , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Humanos , Laparoscopia , Masculino , Miosite/diagnóstico , Miosite/cirurgia , Espaço Retroperitoneal/microbiologia , Choque Séptico/diagnóstico , Choque Séptico/terapia , Futebol/lesões , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/terapia , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgia , Adulto JovemRESUMO
INTRODUCTION: Surgical debridement is the mainstay in the management of infected pancreatic necrosis. Minimally invasive techniques have been shown to minimize surgical insult. We aim to review our recent experience with minimally invasive retroperitoneal pancreatic necrosectomy (MIRP). METHODS: The medical records of consecutive patients between October 2007 and April 2008 who underwent MIRP at our hospital were reviewed. All the patients had a preoperative computed tomography-guided aspiration and positive bacteriologic culture of the peripancreatic collection. RESULTS: Five patients underwent MIRP during the 8-month period. Fourteen procedures were carried out, with a median of 3 (range, 1 to 5) procedures per patient. Only 1 patient required postoperative intensive care monitoring. One patient had a left renal contusion that resolved, and 2 patients developed pancreatic fistula owing to pancreatic duct disruption requiring stenting of the pancreatic duct. There were no mortalities. CONCLUSION: MIRP is a good alternative technique in the management of selected patients with infected peripancreatic necrosis.
Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos , Pâncreas/cirurgia , Pancreatite Necrosante Aguda/cirurgia , Adulto , Idoso , Desbridamento/métodos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pâncreas/microbiologia , Pancreatite Necrosante Aguda/tratamento farmacológico , Pancreatite Necrosante Aguda/microbiologia , Espaço Retroperitoneal/microbiologia , Espaço Retroperitoneal/cirurgiaRESUMO
Cat scratch disease (CSD) is usually diagnosed in patients presenting with regional lymphadenopathy and pyrexia that follow contacts with animals. We describe here a young adult male patient who presented with marked pyrexia and a retroperitoneal abscess without relevant medical histories, illustrating that CSD can be a diagnostic challenge on selected occasions.